Monday, February 4, 2008

Natural History of Disease

Epidemiologists refer to the entire course of an illness as its natural history. On the infectious disease side, this would encompass every single change in the infected person from the very first moment of infection, e.g., the moment when the "germ" or antigen, infectious material as the nomenclature prone like to say, establishes itself within the "host" or infected party and begin to do its nasty business (pathogenesis, if you will).

We've got lots of fancy words for this stuff. There's the asymptomatic period when Mr. Infected Person doesn't even know his precious body has been invaded; there's often a prodrome which is really just a period of time where things don't feel quite right but you're not really ill, per se. And then there's the clinical period when you're sick and you might wish to die and maybe you will or maybe you won't. They call that the tip of the iceberg----lots of infections just hang out there in the pre-clinical/prodrome stages and your immune system kicks their ass and they're done. You win.

There's not a lot of talk about the back side of the natural history curve; like, what do we call those days when you're certain you're not going to die, you don't even really want to much so long as you have your Tylenol and the remote? We just have this blanket term called "reovery". Yeah, well that doesn't seem right to me. Because we all know its gradual and we all recognize it. I'd like to see if I might begin sketching the process out so I might identify with being "in recovery" from this awful damn flu. You guys be sure to let me know what I miss here:

1. The infected person realizes that they've not brushed their teeth for three days and it grosses them out. At this point, the infected person is not able to address the issue but does have some angst over it.
2. The infected person becomes sufficiently energetic to brush teeth so long as the bathroom sink is tall enough to allow leaning and strong enough to support the infected person's weight.
3. The infected person becomes sufficiently energetic to bathe and wash hair (critical feature for this stage) but must return immediately to bed. Will likely require assistance to dress in fresh bed clothes.
4. The infected person, bathed and smelling fresh, may venture away from bed for brief periods of time. At this stage, the infected person may actually wish for food but will likely be unable to identify the only thing that will be palatable to them thus requiring the principal caregiver to endure many iterations of the food preparation, presentation, refusal, storage cycle. This stage actually has a legal term, if not epidemiologic, and I think its covered somewhere under the general provisions for dissolution of marriage. I think.
5. The infected person, if female, will begin to take modest notice of appearances. The donning of jewelry is a positive sign to be encouraged. An ill person with the urge to sparkle is surely a person on the road to wellness.
6. The ill person may experience desire to express themselves verbally or in song but should in NO WAY be encouraged to sing. Trust me.
7. The infected person will seize control of their own nutrition needs in a desperate attempt to rebuild strength to successfully recover. Unfortunately, if this stage requires the ill party to acquire the food from outside sources, they will likely revert to the pre-sparkle phase and be in the middle of that one with the legal provisions. What was that? Four, I think.
8. The infected person will arise after restful sleep, see to daily personal hygiene, attire themselves in street clothes. Having then exhausted all energy available, the infirmed will return to bed.
9. The infected person will telephone their mother to tell them how desperate they are for her attention and chicken/noodles (not soup; just chicken cooked with noodles and some veggies, OK? ENOUGH with the soup!).
10. The infected person, bored beyond hope of reprieve, will find sufficient energy to sit upright and engage in activities sedentary, however banal or annoying.
11. The infected person will don street clothes and feel comfortable in them all day long. They will gradually return to activities of daily living as they continue to feel fatigue and their other symptoms wane.

So, I mean really. This is big stuff. How can we just write it off as "getting better"? Anyone want to guess at which stage I find myself?


Anonymous said...

I hope you're at 11 dear cousin and glad you're not close enough to give it to me. I hope you and your little family feel better soon. LYFE Milo's Nona

Lyman said...

For some reason I was able to read your Tom Petty post on Google Reader but I can't find it here on your blog. Whazzup? Great post, Mike Campbell did rock ballz, he still looks like a young guy.

Over the past couple of years I have realized that a certain amount of showmanship is necessary in music, I just would've liked to have seen a little more. The phallic arrow was indeed a nice touch. There's no reason why Tom Petty can't be as relevant as the crap emo rock heard these days and the kids today need to be hit over the head to realize they are listening to some great shit.

And thanks for the nice words. You are too kind. REALLY!